医科达数字化电子直线加速器控制软件IPV基本原理与应用解读

目的 介绍医科达数字化医用电子直线加速器控制软件里子项目和项目成分值(IPV)的工作原理,并具体说明控制软件通过三类子项目及其项目分项实时监测、控制子系统的运行状态。方法 首先介绍医科达数字化医用电子直线加速器的控制系统组成,然后介绍控制软件里子项目和项目分项的定义和分类,以及各类子项目的基本原理,最后通过分析高功率移相器的运动控制具体说明控制软件的子项目在实时监测、控制子系统运行状态的应用。结果 通过分析原理和举例详细、具体说明了控制软件IPV的工作原理及其应用,使用户尤其是维修人员能掌握相应理论知识,在日常使用和维修时能通过软件快速准确地查找运行参数,并根据相关子系统的控制原理分析问题和解决故障。结论 用户尤其是维修人员掌握这些子项目及其项目分项的工作原理,就能在日常使用或维修、校准时,快速准确地通过控制软件查看、校准运行参数,解决设备故障,并避免错误操作引起事故。     

Trends in advanced imaging and hospitalization for emergency department syncope care before and after ACEP clinical policy

ObjectivesTo describe recent trends in advanced imaging and hospitalization of emergency department (ED) syncope patients, both considered “low-value”, and examine trend changes before and after the publication of American College Emergency Physician (ACEP) syncope guidelines in 2007, compared to conditions that had no changes in guideline recommendations.MethodsWe analyzed 2002–2015 National Hospital Ambulatory Medical Care Survey data using an interrupted-time series with comparison series design. The primary outcomes were advanced imaging among ED visits with principal diagnosis of syncope and headache and hospitalization for ED visits with principal diagnosis of syncope, chest pain, dysrhythmia, and pneumonia. We adjusted annual imaging and hospitalization rates using survey-weighted multivariable logistic regression, controlling for demographic and visit characteristics. Using adjusted outcomes as datapoints, we compared linear trends and trend changes of annual imaging and hospitalization rates before and after 2007 with aggregate-level multivariable linear regression.ResultsFrom 2002 to 2007, advanced imaging rates for syncope increased from 27.2% to 42.1% but had no significant trend after 2007 (trend change: ?3.1%; 95%CI ?4.7, ?1.6). Hospitalization rates remained at approximately 37% from 2002 to 2007 but declined to 25.7% by 2015 (trend change: ?2.2%; 95%CI ?3.0, ?1.4). Similar trend changes occurred among control conditions versus syncope, including advanced imaging for headache (difference in trend change: ?0.6%; 95%CI ?2.8, 1.6) and hospitalizations for chest pain, dysrhythmia, and pneumonia (differences in trend changes: 0.1% [95%CI ?1.9, 2.0]; ?0.9% [95%CI ?3.1, 1.3]; and ?1.2% [95%CI ?5.3, 2.9], respectively).ConclusionsBefore and after the release of 2007 ACEP syncope guidelines, trends in advanced imaging and hospitalization for ED syncope visits had similar changes compared to control conditions. Changes in syncope care may, therefore, reflect broader practice shifts rather than a direct association with the 2007 ACEP guideline. Moreover, utilization of advanced imaging remains prevalent. To reduce low-value care, policymakers should augment society guidelines with additional policy changes such as reportable quality measures.     

中医情志护理联合腹部按摩对肠镜检查肠道准备的影响

目的:观察中医情志护理联合腹部按摩对电子肠镜检查肠道准备的影响。方法:将216例行电子肠镜检查的患者按随机数字表法分为对照组和观察组各108例。2组患者均予以复方聚乙二醇电解质散兑水口服进行肠道准备,对照组患者予常规护理干预,观察组在对照组基础上采取中医情志护理联合腹部按摩干预。采用焦虑自评量表(SAS)评估患者的焦虑状态,Boston肠道准备量表(BBPS)评估肠道准备质量,比较2组SAS、BBPS评分,分析2组肠道准备效果和护理满意度。结果:干预后,2组SAS评分均较干预前下降(P<0.05),观察组SAS评分低于对照组(P<0.05)。观察组护理总满意率为98.1%,高于对照组的90.7%,差异有统计学意义(P<0.05)。观察组右半结肠、横结肠、左半结肠评分及总分均优于对照组,差异均有统计学意义(P<0.05)。结论:中医情志护理联合腹部按摩可以明显缓解电子肠镜检查患者的焦虑情绪,提高护理满意度,提升电子肠镜检查效果。     

基于文献可视化软件的中药治疗糖尿病足知识图谱分析

目的:探索和发现中药治疗糖尿病足领域的热点话题和研究前沿。方法：检索中国知网已发表的中药治疗糖尿病足文献(日期:自建库至2019年6月3日),运用文献可视化软件(CiteSpaceⅤ)绘制中药治疗糖尿病足的知识图谱,进行文献关键词共现分析及聚类分析。结果:该关键词共现聚类网络由909个节点,1 241条边组成,被分成24个聚类。研究热点是:1)中西医结合疗法治疗糖尿病足;2)中药足浴。研究前沿是:1)穴位注射;2)活血化瘀清热解毒疗法。结论:中药治疗糖尿病足的未来之路是注重中医疗法的基础上进行中西医结合,且需更多高质量的证据支持。     

Nobel clinician软件引导上颌窦内提升术在磨牙缺失修复中的应用研究

目的:研究Nobelclinician软件引导上颌窦内提升术在磨牙缺失的应用效果,为临床应用提供指导。方法:选择2016年10月-2018年10月在笔者医院进行手术的86例上颌磨牙缺失患者为研究对象,按照随机数表法分为观察组和对照组,每组43例。对照组:采用常规上颔窦内提升术;观察组:在Nobelclinician软件引导下进行上颌窦内提升术,两组均使用nobelreplace种植体种植。比较两组患者的种植体存留率及种植体周围组织情况[包括术前上颌窦底距牙槽嵴骨高度(Bone height of the maxillary sinus floor from the alveolar ridge,RBH)、术后6个月新骨获得量、术后1年垂直骨丧失、牙周探诊深度(Periodontal probing depth,PPD)];比较两组患者治疗后的X片检查结果及治疗满意度。结果:观察组的RBH、PPD及术后1年垂直骨丧失均显著小于对照组,术后6个月新骨获得量显著大于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后随访6个月,观察组的种植体存留率(100.00%)与对照组(94.55%)相比,差异不具有统计学意义(P>0.05),X片检查结果显示,两组患者的种植体及周围骨组织均结合良好,术后1年均已生成新的上颌窦底壁。观察组患者的满意度(100.00%)显著高于对照组(90.70%),差异具有统计学意义(P<0.05)。结论:Nobelclinician软件引导上颌窦内提升术能够降低垂直骨丧失量,增加新骨获得量,有助于提高磨牙缺失修复的美学效果,提高患者满意度。     

Effect of Day Optimizing Throughput (Dot) Knee Software Implementation on Magnetic Resonance Imaging Workflow Efficiency

PurposeAttempts by magnetic resonance (MR) manufacturers to help imaging centres improve patient throughput has led to the development of more automated acquisition. This software is capable of customizing individual scan alignment; potentially improving imaging efficiency and standardizing protocols. However, substantial investments are required to introduce such systems, potentially deterring their widespread application. This study assessed the implementation costs and reduction in examination durations for automated knee MR imaging (MRI) software.Materials and MethodsResearch activities were performed at a community-based academic centre on a 3-Tesla (3-T) system using Siemens' Day Optimizing Throughput (Dot) knee software. Examination acquisition times were extracted from the system before and after software implementation. Fiscal year 2012/13 finances were used to determine the average hourly cost of MRI utilization. Costs associated with automated software implementation were also calculated. Finally, the number of knee scans required to achieve a positive return on investment using the software was established.Results and DiscussionThe mean (standard deviation, sample size) pre- and post-Dot software scan times were 23.20 (4.18, n = 266) and 21.94 (4.51, n = 59) minutes, respectively, for a routine knee scan and 11.88 (1.60, n = 74) and 11.24 (1.51, n = 27) minutes, respectively, for a fast knee scan. The overall weighted average resulted in a 64-second time savings per automated knee examination. This negligible time savings would be extremely difficult to make use of clinically. Dot simplified 29 unique knee protocols to two, improving the consistency of knee examinations. Current Dot software is not compatible with all patients and therefore has limitations that are a concern among MR technologists.ConclusionAdoption of automated knee systems could assist in standardizing protocols; however, the cost of implementation and difficulty in modifying patient scheduling to reflect the minimal time savings would make a financial return unlikely to occur at small- and medium-sized institutions.